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Antibiotics: The Value of old Innovations

Warning: This post may be TMI if you don’t want to hear about gooey bodily fluids, and not in a fun way.

I have an infected cyst on my back. I was prescribed antibiotics and other than figuring out how to take a pill every 6 hrs on an empty stomach while eating regularly and getting 8 hrs of sleep a night, life is normal. Being of a certain age, I can’t help but wonder if I’d lived a couple hundred years ago, rather than going about business as usual, would I be lying on my death bed, loved ones gathered near? 

Another warning: This post ventures into topics of mortality and morbidity. I’m a scientist, so blood, pus etc aren’t icky to me, rather they’re biological functions of our wonderful ability to fight injury and infection and heal. Also, I’ve decided no one knows what happens when we die, so I’m curious, not afraid. Doesn’t mean I am welcoming death or looking for it, just ok to move on to the next adventure when it comes. If this caviller attitude towards death doesn’t align with your values, I’ll see you on the next post. 

I had a similar infection 30 years ago. I’m surprised how differently my body is dealing with it now. Maybe it’s completely different physiologically, but previously, it blew over in a week. A few days of irritation, a day and a half of fever, then eruption and resolution by the weekend. When I got to the doctor, the diagnosis was ‘seems to have calmed down’. 

This time, it’s on a longer timeline. Irritation for a week. Inflammation for a week. Oozing pus and blood for a week, no two, journeying through the glorious colours of pus, from pearly white to pinkish brown, mixed together in varying quantities of blood and serous fluid. Fortunately, I got to the doctor after week one (same timeline as 30 years ago) and got drugs (no drugs 30 years ago, my body had the situation under control). 

Thus, I wonder: what would have happened to me in a pre-antibiotic era? Did the drugs save my life, considering that my body is slower to fight this off now? 

In the absence of parallel realities, there is no way of answering this question. Unless there are two of me, running an experiment to see who survives of Ann #1 who takes antibiotics and/or Ann #2 who has no antibiotics, isn’t possible. Currently, all we known is the Ann who took antibiotics is still here, writing this post. We don’t know if the Ann without antibiotics would survive.

The scientist in me knows in the paralleled reality of many people, there is uncertainty. Some people would survive with my condition, and a few might not. But it’s hard to say who, if there were 1000’s of people similarly infected, would be fine and who would end up with serious consequences. 

There is a certain (pretty low) probability the infection could turn fatal (through things like sepsis (bacteria in the blood), gangrene (tissue death) or infection by aggressive bacteria like flesh-eating disease). In most cases, the body’s natural defences, which are built to mount an aggressive assault on foreign invaders, will do just that. Predicting when the body’s defences will fail is difficult. It’s easier to deal with the infection early, rather than when the natural defences aren’t enough. So, everyone gets treated, some unnecessarily, some life-saving-ly. 

While getting philosophical about life and death and probability, I noticed some interesting stuff about the business of caring for infections in 2024:

Antibiotic: The drug of choice was a derivative of penicillin, discovered almost 100 years ago1. Sometimes the old standard works fine. 

More antibiotics: I was also given a topic antibiotic – Fucidin cream, commonly used for skin infections. Similarly to penicillin, which comes from mould, fusidic acid comes from a fungus (same biological kingdom)1. I guess best practices for fighting microbes (bacteria) come from more organized microbes (fungi). There is a lesson here about knowing your enemy, or learning from others, or species specialization or nature or something profound. But that’s another post.

Human vs pet medicine: My cat, for her anal gland infections, has been prescribed the same medications as me: same penicillin analog, same topical antibiotic. However, she got her systemic drug in one quick injection. When I asked my doctor why there was a 2 week shot for my pet and I had to take 40 pills over 10 days, his answer was essentially the value proposition was higher for easier to administer drugs for pets. He didn’t say value proposition, but he meant it. This confuses me because there’s value in human convenience, as well as public health (getting people to take all their meds can be a challenge, and with antibiotics, incomplete dosing can contribute to drug-resistant bacteria). 

Apparel for wound healing: The small of the back is central to sitting, lying down, moving, and wearing clothes. Not much else left to do in the course of a day. I’m longing for the early 2000’s when we wore low rise pants. In 2024, I’m left with mid to high rise pants. While some of these may sit far above the mid back, one squat or overhead reach scrapes the waistband across several inches of back. The temptation to buy a new wardrobe was strong, i.e. there’s a market for wound-friendly garments. 

Bandages: Bandage technology has become more specialized. Incredible what you can learn about business strategy in the aisles of the drugstore. 3M, manufacturer of glues, Post-it-notes and tape, has entered the bandage market2. Makes sense, based on the underlying technology (engineering different materials to stick together in various ways – forever, temporary, paper to paper, paper to anything, etc). As there’s generics versions of some of 3M’s products, they’ve been at it for a while. 

To the problem of the back moving all the time, there are bandaids that stretch to allow movement. Put a little lycra in the tape, maybe? Also interesting to see an absorbent pad called ‘hydrocolloid’. This bears are resemblance to the centuries-old concept of a poultice. The basic idea it to put a gob of material that will absorb, actually pull out, fluid from a wound. It’s a physical approach to wound healing, helping to clean and relieve pressure from an injury. 3M and others have put it in a bandaid. Another old innovation that’s still relevant today. 

I will never know if modern medicine saved my life this week. We do know that the discovery of antibiotics has extended human lifespan significantly.1 So, here’s to the smarts that fungi have, that we can borrow, on how to live a long and healthy life. And to the brilliance of human medicine being built on centuries of wisdom. And Victoria’s Secrets for offering a full spectrum of undergarments, perfect for every situation. 

1Good review on many aspects of antibiotics

2Based on their website they did this in the 1990’s.

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